Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When you send for molecular studies for polycythemia vera, what are the mutations that predict increased cardiovascular risk?
This is a very prescient question since arterial and venous thrombosis are frequent events in MPN patients who have polycythemia vera (PV) and these events can precede the diagnosis of PV by several years. Most importantly, we also now know that just having a JAK2 V617F mutation without any clinical...
What chemotherapy regimen would you offer a stage III pMMR rectal adenocarcinoma agreeable to TNT but with significant underlying neuropathy?
It depends on many factors. First, the location of the rectal tumor. Second, other high-risk features - N2 nodes, threatened MRF, etc. Is the patient a surgical candidate? How old is the patient and what other co-morbidities, etc?
Do you continue ADT/Lupron in all patients with castrate resistance prostate cancer?
It is recommended to continue ADT in patients with castration-resistant prostate cancer. Some mechanisms of castration-resistance include upregulation of androgen receptors and autocrine testosterone production, so a castration-resistant cancer is not necessarily a "hormone resistant" cancer.
How would you approach an adult patient >50 years old with an intermediate risk extremity T2N0 fusion neg rhabdomyosarcoma who is progressing on neoadjuvant chemotherapy with VAC?
In the event of disease progression on chemotherapy, it would be advisable to re-examine the pathology of the patient to determine whether the patient has pleomorphic rhabdomyosarcoma, which is a subtype of adult rhabdomyosarcoma. If this is the case, treatment should follow the NCCN guideline for h...
When do you consider performing a diagnostic laparoscopy before neoadjuvant chemotherapy in pancreatic adenocarcinoma patients?
We recommend diagnostic laparoscopy in any patient that is considered a potential resectable candidate in the future. This is especially true for patients who have locally advanced disease, large tumors, elevated CA19-9, lymph node involvement, or tail of pancreas cancer. Diagnostic laparoscopy can ...
Is there a role for radiotherapy to the primary in high volume metastatic prostate cancer with well controlled disease on ADT?
Yes, for some patients. Recent evidence supports an emerging role for prostate RT in the de novo high volume mHSPC population with the goal of preventing serious and symptomatic events from local disease progression. A 2023 update of STAMPEDE arm H demonstrated a significant reduction in the 5-year ...
Do you recommend retreatment with an immune checkpoint inhibitor in a patient with a history of immune checkpoint inhibitor-related AKI that resolved with holding the immune checkpoint inhibitor and a glucocorticoid taper?
Yes. You can rechallenge. The risk of recurrent AIN will be around 16 percent based on the largest study on rechallange. The odds are second time there will be no AKI.
How would you treat a patient with metastatic urothelial carcinoma with early progression on maintenance immunotherapy?
It would depend on the clinical scenario, specifically the disease volume, degree of progression, and whether the patient is deriving clinical benefit despite radiographic progression. Significant early progression in a patient with high disease volume/symptoms is a poor prognostic indicator and we ...
How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?
I maintain that immune effector cell associated hyperinflammatory syndrome is NOT HLH. Most patients post CAR-T cell therapy fulfill the criteria for HLH even if they don’t have hyperinflammatory syndrome, so it makes diagnosis very challenging. Many patients with this “HLH-like” hyperinflammatory s...
When do you feel comfortable adding bevacizumab to a BRAF-WT, KRAS-mutated colon cancer patient with previously hemorrhagic brain mets that responded to radiation?
It should be safe to add bevacizumab at this time. Radiation will reduce vascularity after 4-6 weeks. The incidence of bleeding with Bev (in the absence of anticoagulation) is quite low. Actually lower than the risk of thrombosis or wound healing complications. Go for it.